恩替卡韦预防肺结核并慢性HBV携带者抗结核治疗致肝损伤的临床观察  

Clinical Observation of Entecavir in Prevention of Liver Injury Caused by Anti Tuberculosis Treatment of Pulmonary Tuberculosis and Chronic HBV Carriers

作　　者：杨军[1] 魏敏[2] 范玲[1] 

机构地区：[1]成都医学院第一附属医院感染科,四川成都610500 [2]成都医学院公共卫生系,四川成都610500

出　　处：《四川医学》2017年第2期117-120,共4页Sichuan Medical Journal

基　　金：四川省卫生厅资助课题(编号:130384)

摘　　要：目的观察恩替卡韦预防肺结核并慢性HBV携带者抗结核治疗致肝损伤的临床疗效。方法将110例肺结核并慢性HBV携带者随机等分为试验组和对照组。两组均采用标准方案2H-R-Z-E/4H-R抗结核治疗,试验组同时加用恩替卡韦抗HBV治疗。比较两组肝损伤情况及抗结核治疗结束时HBV DNA的水平。结果试验组肝损伤发生率是16.4%,对照组是41.8%,差异有统计学意义(P=0.003);试验组肝损伤患者ALT、AST及TBIL均比对照组低(P值为分别是0.027、0.001及0.024),肝损伤出现时间也晚于对照组,差异有统计学意义(P=0.015);抗结核治疗结束时,试验组HBV DNA水平比对照组低,差异有统计学意义(P<0.001)。结论肺结核并慢性HBV携带者,在抗结核治疗同时加用恩替卡韦抗HBV治疗,能抑制HBV复制,减少肝损伤的发生率及减轻肝损伤的程度。Objective To observe the clinical effect of entecavir in prevention of liver injury caused by anti-tuberculosis treatment of pulmonary tuberculosis and chronic HBV carrier.Methods 110 cases of pulmonary tuberculosis were randomly divided into experimental group and control group. The two groups were both treated with standard 2H-R-Z-E/4H-R anti tuberculosis treatment,while the experimental group was also treated with entecavir to anti HBV.The liver injury and the level of DNA HBV in the two groups were compared.Results The incidence of liver injury in the experimental group was 16. 4%,the control group was 41. 8%,and the difference was statistically significant（ P = 0. 003）.The ALT,AST and TBIL of the liver injury patients in the experimental group were lower than those of control group（ P = 0. 027,0. 001 and 0. 024）,liver injury appeared later than the control group（ P = 0. 015）; and at the end of anti-tuberculosis treatment,HBV DNA levels were lower than the control group（ P〈0. 001）.Conclusion While treating Tuberculosis and chronic HBV carriers with anti-TB,adding entecavir can inhibit HBV replication,reduce the incidence of liver injury and reduce the degree of liver injury.

关 键 词：肺结核 慢性HBV携带者 恩替卡韦 

分 类 号：R521[医药卫生—内科学]